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PRECISION ENV1RO=TECH CHAIN OF CUSTODY <br /> AND ANALYSIS REQUEST DOCUMENT <br /> CLIENT DETAILS REPORT INFORMATION, <br /> Rush Analysis: 5 Days �2 Days_24hrs_ <br /> Client: � .� I �����- - 7Sampler(s); _O. Mc(�?tl <br /> Subject to surcharge <br /> Customer Number: Comp Sampler Set Up Date: Time: QA/QC report required: yes no <br /> Address: Time: Mileage: If yes,To: State Client Other <br /> Lab number: —: C)Lk 2 G 1( <br /> phone: <br /> _5 x <br /> FAX: <br /> P Ga ° ° it *>rn <br /> E5 Z <br /> Project name: <br /> z W o <br /> F w L x JT <br /> Contact person: <br /> m ;c y <br /> SAMPLE INFORMATION co <br /> 333 ° <br /> Sample Date Time a Q a x Z �3 <br /> Number Location Description Sample Sample z° w t_ ° a y U <br /> CAI GV <br /> 7CUSTODY <br /> 777 Relinquished by t �DTime �Received by: Date2Q1 Time <br /> Relinquished by: Date Time Received by: Date—. Time <br /> Relinquished by: Date Time Received by: Date Time <br /> PRECISION ENVIRO-TECH 7743 N.West Lane, Suite B2* Stockton CA 95210 *Telephone(209)477-8105 *FAX: (209)477-8148 <br /> [" L_._. L.,� L- L. L:_. L,..,_.: L---: L:---: �s L= L . L G__: L- L-.-: L_.: L:.. <br />